直肠内温度变化影响肠易激综合征患者内脏感觉阈值

目的 探讨直肠内温度及压力变化对肠易激综合征(IBS)患者内脏感觉阈值的影响，进一步研究IBS的发病机制。方法 通过直肠球囊内注入空气(压力刺激)、38℃温水、4℃冰水(温度刺激)及脐部放置冰袋加直肠球囊内充气，研究直肠温度和压力变化刺激对初始感觉阈值和排便阈值的影响。结果 (1)直肠球囊内注气后，IBS组患者的初始感觉阈值明显低于对照组，排便阈值差异不明显。IBS组中腹泻型与交替型患者的初始感觉阈值及排便阈值均明显降低；便秘型患者的初始感觉阈值稍低于对照组，排便阈值明显增高。(2)直肠球囊内注入4℃冰水后，除便秘型IBS的排便阈值稍有所增加外，其余患者初始感觉阈值及排便阈值均显著降低，以腹泻型变化最明显。(3)脐部放置冰袋可诱发部分患者产生症状，但对初始感觉阈值和排便阈值无明显影响。结论 直肠温度和压力刺激可明显降低IBS患者的初始感觉阈值和排便阈值，以腹泻型患者最显著。内脏对压力和温度的敏感性增高可能是IBS发病的重要机制之一。

Effects of rectal thermal-and pressure-stimuli on visceral perception thresholds in patients with irritable bowel syndrome

Objective To observe the effects of rectal thermal- and pressure- stimuli on visceral perception thresholds in patients with irritable bowel syndrome (IBS) and investigate its pathogenesis. Methods Rectal visceral perception thresholds were examined in 46 patients with IBS and in 13 normal controls after rectal thermal- and pressure stimuli. Subjects were asked to report its sensation, location and spread. Results Compared with healthy subjects, IBS patients, especially those with diarrhea-predominant IBS, demonstrated significantly lower perception thresholds to rectal thermal and pressure stimuli. Ice had varied effects on symptoms in patients with IBS and no effects on perception thresholds. Conclusion Visceral perception thresholds were decreased significantly after rectal thermal-and pressure- stimuli in patients with IBS. Visceral hypersensitivity is one of the important pathogenesis in IBS.